The COVID-19 pandemic caused the world to open versatile fields and advancements in techniques to the world. The immediate spread of COVID-19 and its impact on human cells are still unknown to date. There were much more gaps and flaws in the COVID-19 in prediction and clinical correlation. The hidden information and lack of communication between different fields is a major drawback to exploring SARS-CoV-2. The enormous workload and tremendous efforts from the health staff managed the COVID-19 pandemic under control. The strategies developed to control the transmission, innovations in detecting SARS-CoV-2 and treatment procedures (Gennaro and Health, 2020).
The diagnostic technique for COVID-19 through the molecular technique for accurate and reliable results. The isolation of SARS-CoV-2 and its tracking for the epidemiological basis to break the chain of infections become enhanced and effective due to rapid detection methods (Carter LJ, 2020, May).
In the early phase of COVID-19 in Pakistan, most cases fell in young and adults group ranging age from 20 to 40 years, and very few cases in old, aged patients. About 71 % were males and 28 % were females at the start of the COVID-19 pandemic (Abid et al., 2020). Pakistan’s population has an average age of about 22 years only and has only 4% of individuals above 65 years and an expected life of 67 years. These demographics show a low mortality rate and low CFR in COVID-19 (Waris et al., 2021). In my study males were 46% affected and females were 54%. Another study reported a high number of males affected than females due to social and cultural factors (Noreen et al., 2020).
Males were 223 (56.2%), and 174 (43.8%) were females and more deaths were reported in males (Sobhani et al., 2021).
The first death by COVID-19 in Pakistan was reported on 18th March 2020 and the ratio began to rise to 1.67% for 100 deaths (Chughtai and Malik, 2020). Patients under 20 years of age were safe from the pandemic and adults from 20 years to 50 years of age were highly exposed by at minor risk with mild effects but the old age group shows a high-risk danger from COVID-19 and a high mortality rate (Chaudhry A et al., 2020).
The COVID-19 cause low deaths in young adults less than 40 years but more death in aged patients above 40 years (Wu and McGoogan, 2020). Researchers grouped the patients having confirmed COVID-19 cases. About 75% of cases were above 50 years of age (Saddique et al., 2021). Our study aligned with the previous reports and about 73.4 % of patients were older than 50 years of age. Age is considered a significant indicator of COVID-19 outcomes. As in my study mean age in recovered and dead patients were similar i.e., 57 ± 16.03 and 60 ±12.12 having a p-value of 0.039. In a study by Pakistani researchers on 317 patients, about 198 (62.5%) were males and 111 (35.0%) were females. The mortality rate was 15.8% among admitted patients (Khalid et al., 2021).
Xavier and his fellows also enlighten the biochemical parameter to focus on prognoses like raised CRP, LDH, and ALT in patients. Hemoglobin shows a decline in value by about 40-50% (Xavier et al., 2020).
Our study shows a minor increase in levels of ALT levels up to 46.50 ± 43.23. Zhang shares his findings of COVID-19 patients having liver dysfunction showing raised ALT levels in 14 to 53% of cases during the infection period (Zhang et al., 2020). Similar findings were reported in MERS-CoV having raised liver enzymes including LDH, ALT and AST. They also share that the recovery rate was enhanced if treated with special attention in mild COVID-19 cases (Zhang et al., 2020).
In our study, CRP raised to a mean of 68.81 ± 70.95 (<5 u/L). The CRP raised to 63.92 ± 69.69 in deceased patients and 112 ± 68.41 in recovered patients. Our study also reports the increase in CRP, a strong biomarker and indicator in death and recovered patients. The level of C-reactive protein elevates up to 49.73 ± 53.59 and a p-value less than 0.001, a highly an important indicator of COVID-19 (Khalid et al., 2021).
Our study also reported elevated levels of biochemical bioindicators. In the study by Chan and his fellow summarizing the elevated levels of CPK, CRP, LDH, and D-Dimer in COVID-19 patients (Chen et al., 2020). The study by Chen on 99 confirmed positive patients admitted to the hospital have raised LDH levels and a study by Huang in 2020 reported the significant levels of serum ferritin, C-reactive protein, and D-Dimer in COVID-19 prognosis (Najim, 2020). Our study conducted on 300 patients showed the level of LDH was extremely high 429.48 ± 246.96 u/L. LDH increase in COVID-19 and have a significant p-value of less than 0.001 between the critical and deceased group(Khalid et al., 2021).
CBC test was performed immediately and reported with distinguished factors giving more in-depth knowledge as a strong biomarker. These biomarkers include neutrophils, lymphocytes, platelets, and white blood cells. In our study hemoglobin remains in the normal range of 12.29 ± 2.11 g/dL with a standard deviation of ± 2.11. The study revealed that admitted patients have normal hemoglobin levels and show no variations (Lei et al., 2020). Hemoglobin level shows no significant correlation (p-value = 0.77). between critical and non-critical patients (Waris et al., 2021).
WBC differential count represents the neutrophil raised to 70 %, CRP 16.16 mg/L, and D-dimer 580 ng/mL in an admitted 33-year-old lady (Lei et al., 2020). Another study conducted on 32 confirmed patients, reported a decrease in lymphocytes and raised neutrophils. They were significant indicators in severe and critical patients (Katipoğlu et al., 2020). Our study supports the previous research and confirms that neutrophilia along with lymphocytopenia were an indicator of COVID-19. Neutrophilia was reported by Singapore on 148 admitted patients having critical illnesses. Gong et al. and Qin et al. and Li et al. also reported similar findings of neutrophilia in admitted patients (Khalid et al., 2021).
In another study, there was a significant correlation between critically ill and mild group patients having a p-value of 0.28 (Waris et al., 2021). In the present study, lymphocytes also show a minor decline, measured at 20.60 ± 13.00% (20.60 ± 13.00). Lymphocytopenia has been observed in the studies of Khalid, Atiqa, et al., CDC, and Huang et al in China among COVID-19 patients (Khalid et al., 2021).
Thrombocytopenia was observed in the COVID-19 patients and predicted the severity and prognosis. Our study showed the platelets counts were below in range (225.29 ± 103.96) and have a p-value of 0.001 between recovered and death groups. The mean platelets count decreased in critical patients to 165.0 × 109/L (Waris et al., 2021). Thrombocytopenia in ventilated patients had a p-value of 0.049, indicating platelets were a major biomarker in COVID-19 (Khalid et al., 2021). Therefore, thrombocytopenia is a major biomarker for identifying coagulopathy.